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One in 3 removable denture users in the United States has denture stomatitis
HARM / ETIOLOGY
A R T I C L E A N A LY S I S & E VA L U AT I O N One in 3 removable denture users in the United States has denture stomatitis ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION Risk factors associated with denture stomatitis in the United States. Shulman JD, Rivera-Hidalgo F, Beach MM. J Oral Pathol Med 2005;34(6):340-6.
SUMMARY Subjects Subjects consisted of a representative sample of the United States (US) noninstitutionalized population from the National Health and Examination Survey III (1988 to 1994). Sample size was 3450 persons older than 17 years old (57.7% men) who wore at least 1 removable denture.
Exposure 3b
Exploratory analyses of a wide range of factors associated with denture stomatitis including sociodemographic characteristics, smoking history, vitamin deficiencies, clinical conditions of removable dentures, and denture use habits.
PURPOSE/QUESTION
Main Outcome Measure
LEVEL OF EVIDENCE
SOURCE OF FUNDING
Presence of denture stomatitis was diagnosed by dentists using the World Health Organization (WHO) criteria. Denture stomatitis was classified as type I in the presence of localized simple inflammation with red spots; type II in the presence of diffuse hyperemic mucosa extending over the entire denture-bearing area, with a smooth surface; and type III in the presence of hyperemic mucosa with a papillary or nodular surface appearance.
Information not available
Main Results
To estimate the prevalence of denture stomatitis in the United States of America (US).
TYPE OF STUDY/DESIGN Cross-sectional design
Denture stomatitis was present in 27.9% (standard error (SE) = 1.05) of removable denture users, with 10.8% (SE = 1.09) being type III stomatitis. Denture stomatitis was associated with younger ages, cigarette smoking, vitamin A deficiency, complete and partial maxillary dentures, continuous use of dentures, and adequate denture relines. Denture stomatitis was not associated with gender, antibiotic and corticosteroid therapies, alcohol and carbohydrate intakes, and diabetes history. Positive smears for Candida spp were found in 7.2% of the lesions.
Conclusions Almost 1 in 3 denture wearers in the US population has denture stomatitis.
COMMENTARY AND ANALYSIS
J Evid Base Dent Pract 2006;6:197<8 1532-3382/$35.00 Ó 2006 Elsevier Inc. All rights reserved. doi:10.1016/j.jebdp.2006.04.011
Denture stomatitis is an inflammation of the mucosa beneath a denture and different degrees of inflammation can be observed. The reviewed study demonstrated that almost 1 in 3 denture wearers in the US population has denture stomatitis and 1 in 10 denture wearers has a more severe denture stomatitis with papillary or nodular surfaces. These prevalences refer to persons with dentures and the corresponding prevalences in the overall US population were reported as 6% and 2.4% in a previous study performed by the same authors of the reviewed study.1 Among the observed risk factors for denture dermatitis, the study confirms that the amount of tissue covered by dentures, vitamin A deficiency, and constant use of dentures are associated with denture stomatitis. However, the study challenges the common belief that Candida spp cause denture stomatitis given the observed low prevalence of positive smears for Candida spp. Another interesting finding is the higher prevalence of denture stomatitis among younger
JOURNAL OF EVIDENCE-BASED DENTAL PRACTICE
denture wearers, which may indicate that besides the higher prevalence of denture use among the elderly, younger individuals are at greater risk of denture stomatitis once they use dentures. The study also highlights the protective effect of poorly adapted dentures, which reinforces the assumption that denture and mucosa should not be in contact for extended periods. These findings give insight regarding the relative contribution of mechanical irritation as an important etiologic factor for denture stomatitis rather than a fungal or bacterial infection. Strengths of the study included the accurate estimate of denture stomatitis in denture users of the US population and the assessment of a wide range of factors potentially associated with denture stomatitis. The use of the NHANES provides an opportunity to estimate prevalences of several oral and dental conditions representative of the whole US population. In addition to dental examination, the national survey has information on sociodemographic and medical characteristics of the participants since a comprehensive interview, medical evaluation, and laboratory exams were performed. NHANES is a rich source of information and its frequent use by dental investigators can stimulate the inclusion of oral and maxillofacial information in future surveys. The cross-sectional design and the lack of reliability assessment of the denture stomatitis diagnosis are 2 important limitations discussed by the authors. The authors acknowledge that the observed factors associated with denture stomatitis cannot be interpreted as causal factors. In addition to these limitations, associations of income and race with
198
Shulman et al
denture stomatitis were not reported in the results, but these variables were mentioned in the methods section. In conclusion, this cross-sectional study demonstrated that denture stomatitis is relatively common among denture users in the United States. Further studies, preferably longitudinal, are needed to understand the etiology and the prognosis of denture stomatitis. The reviewed study highlighted the importance for dentists to be aware of denture stomatitis and for patients to not use the denture continuously in order to prevent denture stomatitis.
REFERENCE 1. Shulman JD, Beach MM, Rivera-Hidalgo F. The prevalence of oral mucosal lesions in US adults: data from the Third National Health and Nutrition Examination Survey, 1988-1994. J Am Dent Assoc 2004; 135(9):1279-86.
REVIEWER Joana Cunha
June 2006
A R T I C L E A N A LY S I S & E VA L U AT I O N One in 3 removable denture users in the United States has denture stomatitis ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION Risk factors associated with denture stomatitis in the United States. Shulman JD, Rivera-Hidalgo F, Beach MM. J Oral Pathol Med 2005;34(6):340-6.
SUMMARY Subjects Subjects consisted of a representative sample of the United States (US) noninstitutionalized population from the National Health and Examination Survey III (1988 to 1994). Sample size was 3450 persons older than 17 years old (57.7% men) who wore at least 1 removable denture.
Exposure 3b
Exploratory analyses of a wide range of factors associated with denture stomatitis including sociodemographic characteristics, smoking history, vitamin deficiencies, clinical conditions of removable dentures, and denture use habits.
PURPOSE/QUESTION
Main Outcome Measure
LEVEL OF EVIDENCE
SOURCE OF FUNDING
Presence of denture stomatitis was diagnosed by dentists using the World Health Organization (WHO) criteria. Denture stomatitis was classified as type I in the presence of localized simple inflammation with red spots; type II in the presence of diffuse hyperemic mucosa extending over the entire denture-bearing area, with a smooth surface; and type III in the presence of hyperemic mucosa with a papillary or nodular surface appearance.
Information not available
Main Results
To estimate the prevalence of denture stomatitis in the United States of America (US).
TYPE OF STUDY/DESIGN Cross-sectional design
Denture stomatitis was present in 27.9% (standard error (SE) = 1.05) of removable denture users, with 10.8% (SE = 1.09) being type III stomatitis. Denture stomatitis was associated with younger ages, cigarette smoking, vitamin A deficiency, complete and partial maxillary dentures, continuous use of dentures, and adequate denture relines. Denture stomatitis was not associated with gender, antibiotic and corticosteroid therapies, alcohol and carbohydrate intakes, and diabetes history. Positive smears for Candida spp were found in 7.2% of the lesions.
Conclusions Almost 1 in 3 denture wearers in the US population has denture stomatitis.
COMMENTARY AND ANALYSIS
J Evid Base Dent Pract 2006;6:197<8 1532-3382/$35.00 Ó 2006 Elsevier Inc. All rights reserved. doi:10.1016/j.jebdp.2006.04.011
Denture stomatitis is an inflammation of the mucosa beneath a denture and different degrees of inflammation can be observed. The reviewed study demonstrated that almost 1 in 3 denture wearers in the US population has denture stomatitis and 1 in 10 denture wearers has a more severe denture stomatitis with papillary or nodular surfaces. These prevalences refer to persons with dentures and the corresponding prevalences in the overall US population were reported as 6% and 2.4% in a previous study performed by the same authors of the reviewed study.1 Among the observed risk factors for denture dermatitis, the study confirms that the amount of tissue covered by dentures, vitamin A deficiency, and constant use of dentures are associated with denture stomatitis. However, the study challenges the common belief that Candida spp cause denture stomatitis given the observed low prevalence of positive smears for Candida spp. Another interesting finding is the higher prevalence of denture stomatitis among younger
JOURNAL OF EVIDENCE-BASED DENTAL PRACTICE
denture wearers, which may indicate that besides the higher prevalence of denture use among the elderly, younger individuals are at greater risk of denture stomatitis once they use dentures. The study also highlights the protective effect of poorly adapted dentures, which reinforces the assumption that denture and mucosa should not be in contact for extended periods. These findings give insight regarding the relative contribution of mechanical irritation as an important etiologic factor for denture stomatitis rather than a fungal or bacterial infection. Strengths of the study included the accurate estimate of denture stomatitis in denture users of the US population and the assessment of a wide range of factors potentially associated with denture stomatitis. The use of the NHANES provides an opportunity to estimate prevalences of several oral and dental conditions representative of the whole US population. In addition to dental examination, the national survey has information on sociodemographic and medical characteristics of the participants since a comprehensive interview, medical evaluation, and laboratory exams were performed. NHANES is a rich source of information and its frequent use by dental investigators can stimulate the inclusion of oral and maxillofacial information in future surveys. The cross-sectional design and the lack of reliability assessment of the denture stomatitis diagnosis are 2 important limitations discussed by the authors. The authors acknowledge that the observed factors associated with denture stomatitis cannot be interpreted as causal factors. In addition to these limitations, associations of income and race with
198
Shulman et al
denture stomatitis were not reported in the results, but these variables were mentioned in the methods section. In conclusion, this cross-sectional study demonstrated that denture stomatitis is relatively common among denture users in the United States. Further studies, preferably longitudinal, are needed to understand the etiology and the prognosis of denture stomatitis. The reviewed study highlighted the importance for dentists to be aware of denture stomatitis and for patients to not use the denture continuously in order to prevent denture stomatitis.
REFERENCE 1. Shulman JD, Beach MM, Rivera-Hidalgo F. The prevalence of oral mucosal lesions in US adults: data from the Third National Health and Nutrition Examination Survey, 1988-1994. J Am Dent Assoc 2004; 135(9):1279-86.
REVIEWER Joana Cunha
June 2006